Provider Demographics
NPI:1336610856
Name:STOLZ, OLIVIA LAUREL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:LAUREL
Last Name:STOLZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:LAUREL
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3300 W LAKE MARY BLVD
Mailing Address - Street 2:220
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3570
Mailing Address - Country:US
Mailing Address - Phone:407-321-7111
Mailing Address - Fax:
Practice Address - Street 1:3300 W LAKE MARY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3499
Practice Address - Country:US
Practice Address - Phone:407-321-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111738363A00000X
FL9111738363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant